Exam #1 Varcolis Ch. 11, 15 ATI 11-13, 21 And 22 Pharm Pgs. 51-66 Flashcards
Causes of depression
Triggers
Genetics
Biochemical
Learned helplessness
Cultural
Major Depressive Disorder
Episodic 2-3 months
suicidal thoughts
-constant state of being unhappy
-psychomotor retardation (slow moving)
-appetite changes
-can’t focus
-sleep disturbance
-energy decreased
-They can’t function in certain areas of life
Persistent depressive disorder
Starts at adolescents
Hard to distinguish
Daytime fatigue
Irritable
Able to function but not optimal
Eating excessively or not enough
Pessimistic thinking
Low self-esteem
Assessment for Depression
Hypothyroidism and vitamin D deficiency can both mimic depression
Cognition and thought content- what is their concentration like?
Suicide and homicide assessment
Previous episodes of depression and coping skills
Ask “what does depression mean to you?”
Depression outcomes
Safety should always be priority
Example outcomes
-patient will name 2 persons of support when suicidal
-patient will gain 5 lbs
-patient will sleep 6-8 hours per night
Implementation
Therapeutic silence
Offering self
Precautionary measures for suicide
Ask patient what is their plan if suicidal
Have a one to one sitter- should not be alone, no harmful items when suicidal
Safety contract- ask for a promise to not overdose
Interdisciplinary treatments
Milieu therapy
Psychotherapy
Mindfulness based cognitive therapy
Group therapy
Antidepressant drugs
SSRIs
SNRIs
Trazadone
TCAs
MAOIs
Bupropion
SSRIs
Citalopram
Escitalopram
Fluoxetine
Paroxetine
Sertraline
SSRIs Uses
Depression with anxiety
Panic disorder
PTSD
OCD
Bulimia
SSRIs side effects
Sleep disturbance
Sexual dysfunction
Tension headaches
Reduced appetite
Hyponatremia
Rash/SJS
SSRIs Adverse Effects
Serotonin Syndrome
Shivering
Hyperreflexia
Increased temperature
Vital sign instability: Increase BP
Encephalopathy
Restlessness
Sweating
Abdominal pain
Increased bleeding tendencies
SSRIs contraindications
Ulcer
GI bleeding
SNRIs
Venlafaxine
Desvenlafaxine
Duloxetine
Levomilnacipran
SNRIs Uses
Major depressive disorder
Anxiety disorder
SNRIs Adverse effects
Serotonin syndrome
Hyponatremia
Trazadone uses
Adjunct therapy for depression
Insomnia
Tricyclics (TCAs)
Amitriptyline
Doxepin
Impipramine
Nortriptyline
Tricyclics (TCAs)
Anticholinergic side effects
Dry mouth
Blurred vision
Tachycardia
Constipation
Urinary retention
Esophageal reflux
Photophobia
Sexual dysfunction
Tricyclics (TCAs) Adverse effects
Orthostatic hypotension
Dysrhythmias
Myocardial infarction
Heart block
TCAs Contraindications
Recent MI
Narrow angle glaucoma
Benign prostatic
Hypertrophy
Seizures
Pregnancy
Monoamine oxidase inhibitors (MAOIs)
Phenelzine
Tranylcypromine
Isocarboxazid
Selegiline
MAOIs adverse effects
Hypertensive crisis
Severe HA or blurry vision
Chest pain, tachycardia
SOB
Diaphoresis, anxiety
Mental status change
Confusion
N/V
MAOIs foods to avoid
Avocados, figs
Fermented, smoked, cured meats, and fish
Bologna, pepperoni, salami
Almost all cheeses
Yeast extract
Some beers
Protein supplements
Shrimp paste, soy sauce
MAOIs contraindications
Cardiovascular disease
HTN, CHF
Liver disease
Recurrent headaches
Recent surgery
Bupropion
Depression
Smoking cessation
Prevention of seasonal pattern depression
Weight loss
Bupropion Adverse effects
Appetite suppression
Seizures
Ketamine Uses
Anesthetic: can be given to aggressive pts
Postpartum depression
Takes away suicidal ideation
Ketamine side effects
Increased BP, HR
Dissociation (high out of body experience)
Light therapy
For mild depression
St. John’s Wort
Interact with all antidepressants
- potentially fatal serotonin syndrome can result if combined with SSRIs
Electroconvulsive therapy Uses
Major depressive disorder
Schizophrenia
Acute Mania
Electroconvulsive therapy
A last resort
Inducing seizures
ECT medications
Atropine: decrease secretions so they don’t aspirate
Propofol: puts them to sleep
Succinylcholine: stops jerking movement
Anxiety
A feeling of uneasiness, uncertainty, or dread
Results from a real or perceived threat
Source of threat is unknown or unrecognized.
Fear
Reaction to a specific danger
You see the threat
Normal anxiety
Can motivate you to do things
Acute anxiety
Example: anxious right before getting surgery
Pathological anxiety
Emotional response that is out of proportion to the threat
Emotional response can continue even after the threat is resolved.
Levels of anxiety
Mild
Moderate
Severe
Panic
Mild anxiety
Ability to learn: good
Physical characteristics
-restless
-mild irritability
-nail biting/finger tapping
-shaking their leg
Moderate
Ability to learn: altered but still possible
Physical characteristics
-tension
-pounding heart
-increased. Respiratory rate and heart rate
-somatic symptoms: using the restroom a lot
-voice tremors
Severe anxiety
Overly focused
Scattered details
Ability to learn: unable
Physical characteristics:
-automatic behavior
-severe somatic symptoms (chest pain)
-hyperventilation
-sense of dread
Panic anxiety
Ability to learn: unable
Characteristics:
-erratic and impulsive behavior (ex: may take off all their clothes)
-hallucinations
-pass out
-dissociate
-freeze
Panic disorders
Recurrent and unexpected panic attacks
monitor for suicide, don’t leave pt alone
Benzodiazepines: help during panic attacks
Anticipatory anxiety: worry a panic attack is going to happen
Symptoms: Nausea, hot flashes
Panic attack
Can last between 1-30 min
Sudden onset of fear or apprehension
not always in response to an acute stressor
Social anxiety disorder
Provoked by exposure to a social situation or a performance situation
Fear is being evaluated or rejected: embarrassment or humiliation
Agoraphobia
Fear of being in places where help might not be available
escape might be difficult or embarrasing
Ex: a grocery store, a park, fear of crowd
Treatment therapy: SSRIs
Generalized anxiety disorder
Excessive anxiety and worry about a number or events and activities
Constant “what ifs”
Treatment: combo of meds and therapy
OCD
Obsessions: uncontrollable, recurring thoughts
Compulsions: ritualistic behaviors
Ex: washing hands 3 times
important to allow them to carry out their rituals, never interrupt
Body dysmorphic disorder
Imagined “defective body part”
Ex: constantly looking at themselves in the mirror, grooming themselves
Hoarding disorder
Excessive collecting of items
Persistent difficulty in parting with possessions
Acceptance and commitment therapy
Part of psychotherapy
Commit to changing their behavior
Meditation
Mindfulness
Focusing on different parts of the body
Ex: yoga
Behavioral therapy
Aversion therapy: focuses on pain, given an undesirable stimulus ex: the pedophile example
Flooding: throwing someone in a situation with the considered threat
Systematic desensitization
Exposure and response prevention
Modeling: holding a cricket to show there is no harm
Thought stopping
Relaxation training
Deep breathing
Guided imagery
Progressive relaxation
Autogenic training
Self-hypnosis
Biofeedback-assisted relaxation
Antidepressants
SSRIs
SNRIs
- Long term treatments
-start with low doses
-prioritize suicide risk
Benzodiazepines
Lorazepam
Clonazepam
Alprazolam
Benzodiazepines uses
Short term treatment
Tolerance develops
Withdrawal symptoms
Addiction
— sedation
—used for the treatment of relief of anxiety and reduce seizures
Benzodiazepines side effects
Amnesia: memory loss
— avoid driving
— impaired judgment
Long term use can lead to dementia and respiratory depression
Benzodiazepines antidote
Flumazenil
Antihistamines
Diphenhydramine
Hydroxyzine
Antihistamine uses
Short term use only
Good for those with substance use disorder
Sedating: therefore helping with anxiety and tension
Buspirone
Non-additive
Long term treatment
2-4 weeks to be effective
Only for long term treatment of anxiety
Can cause orthostatic hypotension, lightheadedness, and dizziness
Kava kava
Elevates mood and feeling of relaxation
Used for the treatment of anxiety and insomnia
Valerian
Best for sleep
Treatment of anxiety and relieve insomnia
Lavender oil
most effective
Boost mood and treat sleep
St. John’s wort
Treatment of depression, anxiety and insomnia
